Crescent Journal of Medical and Biological Sciences
Volume:8 Issue: 1, Jan 2021

Melanoma is the most common and severe type of skin cancer. Patients with melanoma may undergo surgery, chemotherapy, biological therapy (immunotherapy and cancer vaccine designation), radiation therapy, or a combination of these regimens. In addition, at any stage, they may attempt to relieve and control pain and other symptoms of malignancy, along with reducing the side effects of treatment approaches and emotional and practical problems that are treated by managing the symptoms of illness, supportive care, or so-called palliative care. Some therapeutic strategies are the application of immunotherapy and the design of a cancer vaccine which can activate active immune response by stimulating T-cells and reducing the tumor volume and size. Consequently, it creates the memory of immunity. One of the main causes of cancer immunotherapy is T lymphocyte cytotoxicity in cancer. The next strategy is to use immunotherapies (monoclonal antibodies), including antibodies against CD20, CD40, CTLA-4, and PD-1 antigens.

This study was reviewed by using a search of keywords including ‘mRNA vaccination’, ‘monoclonal antibody’, ‘melanoma’, and ‘CD20 antigen’ in Google Scholar, PubMed, and Elsevier databases. Approximately 60 articles were selected that were examined thoroughly.

The results of our study revealed that vaccine cluster of differentiation, monoclonal antibodies are considered as treatments for melanoma cancer.

mRNA plays a key role as the biological treatment of melanoma. More precisely, it is a vector for tumor antigens and a stimulator for inducing antitumor immune responses. In this regard, the study groups use strategies based on the mRNA encoding of the entire mRNA tumor in both in vivo and in vitro environments. Finally, the use of anti-CD20 antibodies with the activator and the inhibitors of immunosuppressive agents have been successful, and surveys in this area have focused on this issue.

The health information governance (HIG) program is an extensive organizational framework for information management across its lifecycle. This program is important as a strategy for the materialization of high-quality care for individuals, social health, and the reduction of the costs of care and the reliability of health information. Considering the spectrum of this program in pioneering countries, the current review aimed to study the HIG program in the selected countries.

This review article was conducted in 2017 by searching for relevant English language articles in PubMed, Scopus, ScienceDirect, and Google Scholar databases, along with the websites of relevant organizations such as Infoway and the American Health Information Management Association. The key terms included, but were not restricted to, ‘health information governance program’, ‘health information management’, and ‘health information governance components’. Finally, the data were analyzed with respect to the aim of the study.

The components of the HIG program, which are classified into 18 main groups, are the principles of this program including nine dimensions of accountability, goal, transparency, integrity, satisfaction with collection and disclosure, protection, compliance, availability, along with retention and disposition. Some officials and legal and natural roles are common among the three countries while some others are specific for each country.

Considering the results of the present study, it is suggested that a strong governance structure together with the policies and regulations of health information technology should be taken into consideration in establishing a HIG program. By developing such a program at a national level, new roles are required to facilitate the implementation of the program.

This study aimed to investigate the role of chest computed tomography (CT) imaging in patient management during COVID-19 pandemic in Saudi Arabia.

A questionnaire including 39 multiple-choice questions was distributed to radiologists and radiographic technologists through social media in Saudi Arabia during 13-23 May 2020, after obtaining the ethical approval.

The results from 33 hospitals in Saudi Arabia showed that the role of CT’s in managing COVID-19 patients was limited to only around 9% of 3049 patients who underwent chest CT. In addition, the CT technologists were exposed to infection with coronavirus in 6 (18%) radiology departments, whereas in the other 27 departments, the CT technologists were not exposed to the infection with the virus.

Despite their high sensitivity, CT scans have played a limited role in the management of COVID-19 and may not be a practical approach to perform routine screening.

Endothelial cell (EC) apoptosis plays a critical role in the physiological and pathological vascular regression, remodeling, and angiogenesis. There are several therapeutic agents such as glucocorticoids (GCs), which could influence EC apoptosis, causing coagulation events. Due to the paradoxical effects of GCs on cellular apoptosis, the aim of the current study was to investigate the dose and time in which GCs could initiate and terminate in vitro cellular apoptosis.

Dexamethasone (DEXA) was serially diluted 10-folds for 8 serial concentrations (from 1 mM to 0.1 nM) added to cultured human umbilical vein endothelial cells (HUVECs). The cytotoxic effects of DEXA on HUVEC were tested with a rapid colorimetric test using 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide assay. Apoptotic assays based on quantitative polymerase chain reaction was performed for Bax and Bcl-2 genes and terminal deoxynucleotidyl transferase dUTP nick end labeling assay.

DEXA at the concentration of 1 µM showed significant cytotoxic effects, more intense anti-apoptotic effects in lower concentrations (1 nM to 100 nM), and anti-apoptotic effects with less intensity in higher concentrations (10 µM to 1 mM). Six hours of treatment by 1 µM of DEXA was estimated as the initial time of DEXA that could remarkably induce HUVECs apoptosis. The maximum significant increase of apoptosis was detected 24 hours after treatment with DEXA.

Our findings suggested that GCs can influence cellular apoptosis in a dose- and time-dependent manner.

The purpose of the current research was to investigate the existence of aac(6´)-Ib-cr and qnr (qnrS, qnrD, qnrC, qnrB, and qnrA) genes and determine antibiotic sensitivity patterns in Klebsiella pneumonia strains, recovered from hospitalized patients in Shiraz, southern Iran.

In the current cross-sectional study, the strains isolated from the clinical specimens of hospitalized individuals were tested during 2014-2016 in Shiraz, Iran. The culture was done on microbiological media, and the strains were recognized as K. pneumonia based on biochemical tests in the analytical profile index-20E diagnostic strip. All the strains were investigated for antibacterial sensitivity using the CLSI standard guidelines. Gene-encoding antibiotic resistance markers consisting of aac(6’)-Ib-cr, qnrS, qnrD, qnrC, qnrB, and qnrA were evaluated by polymerase chain reaction (PCR) assay.

Ninety-six strains of K. pneumoniae, isolated from hospitalized patients, were entered into the research. Based on the results, 51.04% of strains were recovered from females, and 35.66% of patients were hospitalized in the intensive care unit. Sixty-two strains were isolated from the urine. Imipenem was the most efficient drug against the strains (81.52%). Less than 50% were sensitive to the new generation of quinolones. All isolates harboring antibiotic resistance genes were non-susceptible or at the intermediate level of resistance to ciprofloxacin (CIP). Most aac(6’)-Ib-cr+ strains were non-susceptible or at the intermediate level of resistance to piperacillin/tazobactam. In PCR assay, 27.08% of isolates had antibiotic resistance traits (aac(6’)-Ib-cr, qnrS, qnrD, qnrC, qnrB, and qnrA). Finally, aac(6’)-Ib-cr, qnrS, and qnrB markers were found in 7.3%, 10.4%, and 7.3%, respectively.

In this research, the emergence of potentially virulent and carbapenem non-susceptible cases in conjugation with a quinolone-resistant genotype is alarming, thus vigorous clinical manifestations, along with drastic constraints in therapy would be a possible result in this regard.

Abstract

Mizaj (temperament) refers to a concept in Persian medicine and is the basis for defining health and disease. Brain, as the most important organ of the body (Aza-e-raeiseh), controls vital functions. So far, no standardized questionnaire has been designed for distinguishing temperament in Persian medicine. Therefore, the aim of this study was to provide a reliable objective self-report questionnaire and a standardized diagnostic checklist for Mizaj identification via determining their reliability and validity in Persian medicine.

This was an exploratory sequential study in which we designed a 121-item questionnaire, and a 20-item checklist as an item pool using Mizaj-related indices searched in Persian medicine references. The number of items for questionnaire and checklist finally reached 35 and 12 after qualitative and quantitative assessments (e.g., content and face validities). The test-retest reliability of each question of the questionnaire and checklist and their consistency were evaluated by participation based on the weighted and Fleiss’ kappa statistics, and intraclass correlation coefficient (ICC). The final version of the questionnaire and checklist were divided into two subscales (i.e., warm/cold and wet/dry), and the minimum and maximum scores were determined.

Significant findings of our data showed that the weighted and Fleiss’ kappa coefficients of the 35-item questionnaire (between 0.4 and 0.9) and 12-item checklist (between 0.4 and 0.8) were found in the study based on their reliability. The degree of reliability in the self-report questionnaire was assessed using weighted kappa (WK), where 6 items of the questionnaire were omitted due to a WK less than 0.6 and the number of items reached 35. While 2 items of the checklist with Fleiss’ kappa (FK) <0.2 were omitted and the number of items reached 12 items. WK coefficients of the 35-item questionnaire (between 0.4 and 0.9) and 12-item checklist (between 0.4 and 0.8) were found in the study, suggesting their reliability. The highest WK was found to be linked to sleep, and psychic and physical functions, suggesting the appropriateness of questions/items and design. The calculated ICC of the two stages for the warm/cold and wet/dry subscales of 35-item questionnaire was determined as 0.92 and 0.91, respectively, showing the stability of total score. ICC of the final score for the warm/cold subscale of the 35-item questionnaire was 0.88 (0.86 to 0.96), while this value was 0.91 for the wet/dry subscale (0.83 to 0.95).

The present questionnaire and checklist were validated in terms of the design, reliability, and validity of a standard Mizaj determination questionnaire and checklist. The final questionnaire and checklist may be capable of distinguishing Mizaj of brain at the clinical and research levels for Persian medicine practitioners.

Chronic inflammation in urothelial tissues can lead to DNA damage and cancer formation. Inflammatory reactions in bladder cancer (BC) probably depend on the stages and grades of tumors. The aim of this research was to find out if there is a relationship between the serum levels of selected inflammatory factors and the pathological grades/stages of tumors in new cases of non-muscle invasive urothelial bladder carcinoma patients.

Blood samples were collected from 40 newly diagnosed non-muscle invasive urothelial bladder carcinoma patients (before the surgery) and 40 normal individuals without the signs of acute and chronic diseases or cancer. All patients had proven BC and were sampled prior to the initial transurethral resection of bladder tumor and any medical intervention. Finally, the levels of selected inflammatory factors such as C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) were measured using enzyme-linked immunosorbent assay kits.

Based on the results, the levels of IL-6 (3.041.32± vs. 0.76±0.23), TNF-α (18.5±5.24 vs. 10.52±2.67), and CRP (807.09±564.86 vs. 132.08±53.76) were significantly higher in samples obtained from cancer patients compared to the control group, respectively (P<0.001). In addition, changes in these markers were associated with tumor stages and grades (P<0.001). Eventually, there was a significant increase in the risk of non-muscle invasive bladder cancers (NMIBC) with elevated levels of IL-6 (odds ratio [OR]: 5.93) and TNF-α (OR: 2.39).

Overall, the results revealed a desirable relationship between the levels of inflammatory factors and tumor stages/ grades in NMBIC cases. These data may suggest that IL-6 and TNF-α are responsible for predisposing epithelial cells to genotoxic agents and cancer development. Finally, IL-6 and TNF-α, together with CRP are valuable inflammatory factors for the diagnosis of new BC cases.

Rosemary has been broadly used in food, cosmetic, and pharmaceutical industries due to having different groups of main secondary metabolites (phytochemicals). There are many ways to reach the aim of the maximum percentage of active compounds. Regarding the importance of the essential oil (EO) and hydroxycinnamic acid derivatives, as well as ease of the harvesting time control, these factors were selected in this study although the variations of the chemical content of rosemary were evaluated during one day contrary to previous reports.

The fresh aerial parts of the cultivated rosemary were hand-harvested in winter at three different times (i.e., before sunrise, at noon, and after sunset) and then dried at 30°C. Each sample was submitted to the Clevenger-type apparatus for the isolation of the EO. The dried EOs were analyzed by gas chromatography (GC)/flame ionization detector (FID) and gas chromatography-mass spectrometry (GC/MS), and total hydroxycinnamic acid derivatives were determined by the UV/Vis spectrophotometer. Finally, the results were validated by the ANOVA test.

The maximum (3.65%) and minimum (1.61%) of the total EO were obtained before the sunrise and after the sunset with 24 and 26 components, respectively. In addition, the results of GC/MS revealed that 1, 8-cineole, α-pinene, and camphor are the three most dependable components in the EO to the harvesting time. The contents of α-pinene and 1,8-cineole reduced from 32.8% to 23.0% and from 23.6% to 10.5% although the camphor percentage increased from 2.7% to 9.8% in the variation of the harvesting time from before the sunrise to after the sunset. In contrary to the EO, UV/Vis spectrophotometry results showed that hydroxycinnamic acid derivative contents were undependable over different harvesting times.

Based on this investigation, rosemary can change their component in some groups, and thus the harvesting time can be optimized based on our needs.

Helicobacter pylori is the cause of many stomach diseases such as chronic gastritis, peptic lesion, gastric cancer, and dyspepsia. It is indicated that the process of inflammation is associated with nitrosative stress. Besides, polyunsaturated fatty acids (PUFAs) have strong protective effects against inflammatory diseases, as well as bactericidal effects. Therefore, this study evaluated the beneficiary effects of PUFAs against nitrosative stress in patients infected with this bacterium with dyspeptic symptoms.

This study was a double-blinded clinical trial and the participants were 34 patients infected with H. pylori with dyspeptic symptoms. The patients were divided into 2 groups, and written consent was obtained from all participants. The control group was treated with a current antibiotic regimen and the case group was treated with an antibiotics regimen and PUFA supplement for 2 weeks. Then, biopsy and juice samples from patients’ stomachs were obtained before and after the treatment. The stomach biopsies were used for a quick urease test and juice samples were used via the Griess method for investigating nitric oxide (NO) levels.

In gastric mucosa, the mean levels of NO significantly reduced (P<0.0001) after treatment in the case group (5.36 ± 1.16 mmol/L( compared with the control group (2.72 ± 1.13 mmol/L).

The results showed that using omega supplement can improve the nitrosative stress occurred in patients with H. pylori infections and is useful for decreasing NO. Thus, it is suggested that the consumption of omega fatty acids in combination with standard therapy is effective in H. pylori eradication.

Considering the unwanted and undesirable side effects of opioid pain control after thoracoscopic surgery, the present study aimed to compare intrapleural bupivacaine vs. bupivacaine + ketamine on post-thoracoscopic pain control.

This randomized clinical trial study was performed on 60 candidates for thoracoscopy in Imam Reza hospital (Tabriz-Iran) during 2014-2016. The intervention was started after the random allocation of patients into control and intervention groups each containing 30 people. Before the surgery, patients in the control group received bupivacaine and those in the intervention group received bupivacaine + ketamine through an intrapleural catheter. Then, pain intensity and a need for an opioid after the surgery were measured in two groups based on visual pain criteria. The results of the two groups were compared by paired t test, chi-square test, and Mann-Whitney test using SPSS 23.

Based on the results, the intensity of pain was significantly lower in the intervention group 6 (P=0.032), 12 (P=0.049), and 24 (P=0.048) hours after the surgery compared with the control group, and the amount of the consumed pethidine in both groups showed that the average pethidine consumption in the intervention group was significantly lower compared to the control group in the first (P=0.009), the second (P=0.014), the third (P=0.031), and the fourth (P=0.02) six hours after the surgery.

In general, intrapleural low-dose ketamine in combination with bupivacaine is effective in post-thoracoscopy pain control.

The present study aimed to examine the expression of CD44 and claudin-1 markers using immunohistochemical methods to differentiate patients with minimal change disease (MCD) from those afflicted with focal segmental glomerulosclerosis (FSGS).

In this descriptive-analytical study, twenty patients with definite FSGS, twenty patients with FSGS/MCD spectrum, and seven patients with definite MCD were randomly chosen from Imam Reza hospital affiliated with Tabriz University of Medical Sciences. All patients underwent renal biopsy, and then the presence of the immune complex was examined in the obtained samples using immunofluorescence staining. Some renal specimens were paraffin-embedded for the evaluation of the expression levels of CD44 and claudin-1 utilizing the immunohistochemistry method.

Among the twenty samples obtained from patients with definite FSGS, 13 samples (65%) were double-positive for CD44 and claudin-1, 3 specimens (15%) were positive only for claudin-1, and 4 samples (20%) were double-negative for CD44 and claudin-1. The percentages of renal specimens expressing claudin-1 in patients with definite FSGS, FSGS/MCD, and MCD were 80%, 85%, and 0%, respectively. Finally, the percentages of renal samples expressing CD44 in patients with definite FSGS, FSGS/ MCD, and MCD were 65%, 10%, and 0%, respectively.

The results of the present research indicated that the rate of CD44-positive specimens was higher in patients with FSGS while the percentage of claudin-1-positive samples was more frequent in MCD patients compared with FSGS patients.

The prevalence of attention deficit hyperactivity disorder (ADHD) in children has been rising more rapidly in recent years. Studies have shown that attention to the nutritional deficiencies in these children can be effective in controlling symptoms. Therefore, we decided to examine the magnesium supplementation in children with ADHD under treatment with methylphenidate.

The study was conducted on 40 children with ADHD. The children were randomly assigned to 2 groups. The intervention group (n = 20) received magnesium tablets (10 mg/d) with methylphenidate (0.5 to 1 mg/kg/d) for eight weeks and the control group (n = 20) received placebo with methylphenidate (0.5 to 1 mg/d). Both groups were assessed before and after the intervention using the Conner’s parent rating scale.

At baseline, the mean total score was 74.4 ± 10.4 in the intervention group and 76.8 ± 6.6 in the control group (P=0.79). At the end of the study, the total score of Conner’s Parent Rating Scale was 61.9 ± 11.1 in the intervention group and 68.8 ± 7.3 in the control group (P=0.02). There was also a significant difference between the groups in the scores of the inattention subscale at the end of the study (P=0.001).

The findings of the present study suggest that magnesium supplementation with methylphenidate can be effective in reducing ADHD symptoms.

Atrial septal defect (ASD) is one of the congenital diseases of the heart, which causes large cases of ASD requiring therapeutic interventions. In the event of a large defect of the atrial wall of the heart, the amount of blood shunted from the left atrium is noticeable and the amount of pulmonary blood flow increases, which can be associated with several symptoms and complications such as respiratory distress, recurrent infections, pulmonary artery hypertension, and large cavities. The right side of the heart is accompanied with failure, thus this abnormality needs treatment. The closure of secondum ASD as one of the congenital heart diseases can be conducted by transcatheter or open-heart surgery. Given the above-mentioned explanations, the present study was conducted to compare the two above-mentioned methods.

In general, 60 patients treated with open-heart surgery (n=30) and transcatheter (n=30) were evaluated in this study. The two groups were compared in terms of success rate, hospitalization time, hospitalization costs, and complications such as infection, bleeding, arrhythmia, cardiac block, endocarditis, and the need for post-operative re-intervention.

Both groups were effectively treated with either of these two methods. The mean age of surgical patients was significantly (P=0.003) lower than those treated with transcatheter. Although the group treated with open-heart surgery had higher amounts of bleeding, arrhythmia, infection, heart block, hospitalization costs, and re-intervention, these differences were not statistically significant. During the study, none of the patients had endocarditis and none died as well. Finally, patients treated with transcatheter had a mean (standard deviation) duration of the hospitalization of 4.3 (±1.39) days, which was significantly lower (P<0.001) than the surgical method 11.1 (±4.6).

Both trans-catheterization and open-heart surgery treatments are effective in treating patients with secondary ASD although the use of the transcatheter method is less risky and more cost-effective due to the findings in comparison with the openheart surgery method. However, care should be taken in choosing the patient for this therapeutic intervention. In addition, patients treated with trans-catheterization had a shorter duration of hospitalization, which could be important in terms of family relocation to other family members and the system of treatment. Eventually, due to the high rate of bleeding from patients of young age in both groups, preclinical tests should be performed before the surgery in this age group in order to improve therapeutic techniques.